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INTRAUTERINE DEVICES

INTRAUTERINE DEVICES. Types of UDs: First generation IUDs: non medicated Second generation : copper containing Third generation : hormone releasing. In india under national family welfare programme CU-T-200B is being used. From year 2002,Cu-T-380 A has been introduced in the programme.

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INTRAUTERINE DEVICES

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  1. INTRAUTERINE DEVICES

  2. Types of UDs: • First generation IUDs: non medicated • Second generation : copper containing • Third generation : hormone releasing

  3. In india under national family welfare programme CU-T-200B is being used. • From year 2002,Cu-T-380 A has been introduced in the programme

  4. First generation IUDs: • Lippes loop • Double shaped device • Made up of polyethylene • Contains small amount of barium sulphate to allow X-ray examination • Has a tail made up of nylon • Exists in four sizes A,B,C,D

  5. Second generation IUDs: • Came up in 1970s by adding Cu to the IUDs • Metallic copper was known to have strong anti-fertility effects • The numbers included in the names refer to the surface area(in sq. mm) of the copper on the device.

  6. Cu-T-200B Nova T

  7. Earlier devices: - Copper 7 - Copper T-200 • Newer devices a. Cu-T-220 C Cu-T-380A • Nova T • Multiload Cu 250,375

  8. MULTILOAD 375

  9. Advantages: • Low expulsion rate • Lower incidence of side effects eg.pain and bleeding • Easier to fit in nulliparous women • Better tolerated by nullipara • Increased contraceptive effectiveness • Effective as post coital contraceptive

  10. Third generation IUDS: -Progestasert : T shaped device filled with 38mg of progesterone -LNG-20: a T shaped IUD releasing 20mcg of levonorgestrel

  11. LEVONOGERSTREL IUD

  12. PROGESTASERT

  13. Mechanism of action of IUDs: -causes cellular and biochemical changes in the endometrium -these changes impair the viability of the gametes and hence reduce its chances of fertilization -hormone releasing IUDs increase the viscosity of the cervical mucus and thereby prevent sperm from entering the cervix.

  14. Effectiveness:

  15. Change of IUDs: -lippes loop may be left in place indefinitely. -Cu-T-380A is approved for 10yrs -NOVA T for 5 yrs -levonogestrel used for atleast 7 yrs.

  16. Advantages of IUDs: • Simple to insert • Insertion takes place only few minutes • Inexpensive • Contraceptive effect is reversible • Virtually free of systemic metabolic side effects associated with hormonal pills. • Highest continuation rate

  17. Contraindications a. absolute • Suspected pregnancy • Pelvic inflammatory diseases • Vaginal bleeding • Cancer of cervix, uterus • Previous ectopic pregnancy

  18. Relative: -anaemia -menorrhagia -history of PID -purulent cervical discharge -distortions of the uterine cavity

  19. Ideal IUD candidate: The planned parenthood federation of america(PPFA) -who has borne at least one child -has no history of pelvic disease -has menstural period -is willing to check the IUD tail -has acess to follow-up and treatment of potential problems -is in a monogamous relationship.

  20. What is the ideal time for insertion and why is follow-up important??

  21. Side effects and complications: -bleeding -pelvic infection -uterine perforation -pregnancy -ectopic pregnancy -expulsion -fertility after removal -cancer and teratogenesis -mortality -pain

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